Thyroid Disease Hyperthyroidism An Overview of Graves' Ophthalmopathy By Troy Bedinghaus, OD linkedin Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association. Learn about our editorial process Troy Bedinghaus, OD Medically reviewed by Medically reviewed by Danielle Weiss, MD on March 02, 2021 linkedin Dr. Danielle Weiss is the founder of Center for Hormonal Health and Well-Being, a personalized, proactive, patient-centered medical practice with a unique focus on integrative endocrinology. She enjoys giving lectures and writing articles for both the lay public and medical audiences. Dr. Weiss is Assistant Clinical Professor of Medicine at the University of California, San Diego. Learn about our Medical Review Board Danielle Weiss, MD on March 02, 2021 Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Graves' disease is a thyroid disorder that can have a profound effect on the eyes. Some people with Graves' disease can develop a condition known as Graves' ophthalmopathy, or thyroid eye disease. In Graves' ophthalmopathy, inflammation can affect muscles and other tissues around the eyes. 1:33 How the Thyroid Gland Works Symptoms If you develop Graves' ophthalmopathy, inflammation and other immune system events can affect the muscles and other tissues around your eyes. Known as exophthalmos, or proptosis, bulging of the eyeballs is a distinguishing symptom of Graves' disease. Exophthalmos often causes the eyes to feel achy, dry and irritated, as the eyelids become unable to perform their duty of sheltering the eyes from injury. Signs and symptoms of Graves' ophthalmopathy include the following: Bulging of the eyes (exophthalmos) Seeing the whites of the eyes all around the pupil Pressure or pain in the eyes Gritty sensation in the eyes Puffy eyelids Red, burning eyes Light sensitivity Double vision (diplopia) Reduced vision Illustration by Cindy Chung, Verywell Causes Graves' ophthalmopathy occurs in about 30% of people with Graves' disease of the thyroid. In most cases, the immune system attacks the muscles and other ocular tissues of the eye. Inflammation causes swelling and scarring. The cornea may be damaged by the bulging forward of the eyes. Inflamed or scarred muscles that hold the optic nerve in place may also become damaged, resulting in vision loss if left untreated. Diagnosis If you feel that you are developing signs of eye problems associated with Graves' disease, you will need to have a complete eye exam with an ophthalmologist. Graves' disease sometimes causes inflammation and swelling in the soft tissues and muscles that surround the eyes, often causing the eyeballs to bulge or protrude from their sockets. Doctors will complete a physical exam by looking at the eyes for signs of irritation or signs of the eyes protruding. They will also examine the thyroid gland to see if it is enlarged. Treatment Most of the symptoms of Graves' ophthalmopathy can be treated successfully. Because the eyes may be protruding, the eyelids may not close all the way during sleep or normal blinking, causing irritation. To minimize eye irritation, artificial tears may be used several times per day and ointments may be applied at night to prevent the eyes from drying out. Steroids, such as prednisone, may be given to reduce swelling behind the eyes. If the eyes are protruding to a great degree, a surgeon may perform orbital decompression surgery. This procedure involves removing the thin bones that make up the orbit of the eye so that the eyes may move back to a more normal position. This is also important because the pressure inside the eye can increase if a considerable amount of pressure builds up around the eye, raising the risk of developing glaucoma. Eye muscle surgery may be performed if needed, and eyeglass prisms may be prescribed if the eye muscles are so swollen that the eyes can no longer be aligned properly. Was this page helpful? Thanks for your feedback! Losing weight with thyroid disease can be a struggle. Our thyroid-friendly meal plan can help. Sign up and get yours free! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Mcalinden C. An overview of thyroid eye disease. Eye Vis (Lond). 2014;1:9. doi:10.1186/s40662-014-0009-8 Bahn RS. Graves' ophthalmopathy. N Engl J Med. 2010;362(8):726-38. doi:10.1056/NEJMra0905750 Bausch & Lomb Incorporated. Graves’ disease (graves’ ophthalmopathy) Griepentrog GJ, Garrity JA. Update on the medical treatment of Graves' ophthalmopathy. Int J Gen Med. 2009;2:263-9. doi:10.2147/ijgm.s6856 Additional Reading Bartlett JD, Siret J. "Clinical Ocular Pharmacology," Chapter 27: Thyriod-Related Eye Disease, pages 699-724. Butterworth-Heinemann, 1989.